Tools For Optimizing Pharmacotherapy in Psychiatry Discussion

Pharmacology

Questions to ask

According to the case study provided, it is apparent that the patient is suffering from a major depressive disorder. This is evidenced by an alteration in his sleeping pattern and also feelings of depression since the demise of his spouse (Lovestone, S., & Howard,2020). Some of the essential questions to ask the patient would include,

1. When did you start encountering sleeping problems? This question would help me distinguish the severity of the illness and the system involvement level.
2. How can you describe the way you are feeling today? This is an open-ended question, and it would help me analyze and better understand the situation deeply.

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• How would you describe your typical day and bedtime routine? The patient has reported to the facility with complaints of interrupted sleep patterns; environmental factors are known to hinder one’s circadian rhythm. Tools For Optimizing Pharmacotherapy in Psychiatry Discussion

Physical exam and diagnostic tests

Performing various diagnostic tests would be essential for this patient since only a little information had been provided earlier during the history taking. One of the diagnostic tests would be the urine culture test; the majority of the geriatrics do not have visible symptoms; hence there is a great need for the healthcare workers to conduct various diagnostic tests. Study by Tortora and Derrickson (2018) states that the majority of the systems of the old persons have atrophied; thus, getting accurate assessment findings is very difficult. Secondly, a Depression scale, for example, the Becks depression scale, would help me quantify the depression levels of the patient. Last task is the sleep regime; this would help determine the patient’s sleep habits which would provide information on any other possible triggers of the condition.

Differential diagnosis

The most probable diagnosis for the patient is Major depressive disorder. In my opinion, the patient’s history has most of the depressive symptoms. According to Tolentino and Schmidt (2018), the DSM-V for major depressive disorder should include depressed mood, insomnia, fatigue, weight loss and decreased concentration. From the patient’s history, some of the symptoms that she presents with are similar to that of the DSM V. The most likely differential diagnosis is Adjustment Disorder with Depressed Mood. I believe that the patient is still trying to adjust after his spouse’s loss, which has made him have difficulties sleeping.

Pharmacological agents

Zoloft, a trade name for sertraline, is an antidepressant that is classified under the selective serotonin inhibitors (SSRIs). In adults, a dose of 50mg per oral is believed to be efficient for use. It is regarded as the first drug of choice among elderly patients due to the low potential for drug interactions (Eap et al.,2021). Zoloft would be the most efficient drug over fluoxetine and paroxetine since the patient is already on antihypertensive medications; thus, minor medication interference will be beneficial (Romero et al.,2019). It is contraindicated for patients taking Monoamine oxidase inhibitors and those with severe renal impairment. Some of the side effects include anxiety, dizziness, neuroleptic malignant syndrome and paresthesia. The second drug is Melatonin, a hormone that is produced by the pineal gland. Melatonin is believed to play a critical role in regulating sleep patterns. Some of its side effects include increased prolactin levels and nausea. Tools For Optimizing Pharmacotherapy in Psychiatry Discussion

Checkpoints

I will request the patient to come back for a checkup after four weeks to assess the drug regime’s effectiveness, her adherence, and any side effects.

Lessons Learnt from the case study

From this case study, I have learnt that depression can be worsened by losing someone dear to us, and symptoms may present after a while. Secondly, each drug has a side effect, and the nurse should be watchful when administering them to any patient, regardless of the status.

References

Eap, C. B., Gründer, G., Baumann, P., Ansermot, N., Conca, A., Corruble, E., … & Hiemke, C. (2021). Tools for optimizing pharmacotherapy in psychiatry (therapeutic drug monitoring, molecular brain imaging and pharmacogenetic tests): focus on antidepressants. The World Journal of Biological Psychiatry, 22(8), 561-628.

https://doi.org/10.1080/15622975.2021.1878427

Lovestone, S., & Howard, R. (2020). Depression in elderly people. CRC Press.

Romero-Martínez, Á., Murciano-Martí, S., & Moya-Albiol, L. (2019). Is sertraline a good pharmacological strategy to control anger? Results of a systematic review. Behavioral Sciences, 9(5), 57.

https://doi.org/10.3390/bs9050057

Tolentino, J. C., & Schmidt, S. L. (2018). DSM-5 criteria and depression severity: implications for clinical practice. Frontiers in psychiatry, 9, 450.

Tortora, G. J., & Derrickson, B. H. (2018). Principles of anatomy and physiology. John Wiley & Sons. Tools For Optimizing Pharmacotherapy in Psychiatry Discussion